Impaired comfort is a multidimensional diagnosis used to describe the physical, emotional, social, cultural, and spiritual challenges a patient encounters. Comfort levels vary between patients and age groups and are dynamic. It is recommended the nurse assess for a specific cause of impaired comfort as much as possible in order to best intervene.
Pain and symptom control aren’t the only ways to improve comfort. Patients need to feel comfortable in their environment, connected spiritually, have family present, receive timely assistance, be involved in their treatment plan, and feel engaged with committed staff members. Evidence shows that patient comfort is directly related to the overall patient experience.
It may not be possible to eliminate all aspects of discomfort, but the nurse has a unique opportunity to create a safe environment that allows for peace and a sense of control.
Causes of Impaired Comfort (Related to)
- Inadequate sleep
- Worry and overwhelm
- Nausea and vomiting
- Unfamiliar surroundings (hospitalization)
- Imbalanced thermoregulation
- Loss of support systems
- Conflicts with cultural or spiritual beliefs
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Verbalizes pain, exhaustion, or general unwellness
- Expresses feeling stressed or worried
- Expresses concern about their health or a procedure
- Verbalizes a sense of unease surrounding finances, faith, or support systems
Objective: (Nurse assesses)
- Signs of pain: grimacing, guarding, moaning, diaphoresis
- Irritability or restlessness
- State of panic or anxiety
- Rapid breathing
- Increased heart rate
- Patient will appear calm and relaxed with vital signs within normal limits
- Patient will report a pain score of 3 or less out of 10
- Patient will state two methods to control their stress and worry
Nursing Assessment for Impaired Comfort
1. Assess physical causes of discomfort.
Pain, nausea, fatigue, and medical equipment such as IV lines and catheters can cause impaired comfort.
2. Assess pain level.
Monitor the pain level closely using a pain scale (verbal or nonverbal).
3. Assess for mental or emotional feelings of discomfort.
The nurse may observe outward signs of discomfort such as restlessness or tearfulness, but the patient may be struggling with an emotional challenge.
4. Ask the patient about their comfort goals.
There are some instances that the nurse may not be able to control, or the patient may not have a realistic understanding of the situation.
Nursing Interventions for Impaired Comfort
1. Be kind.
The easiest and foremost action the nurse can take with patients is to be kind. Smile, use a warm tone of voice, and emit a sense of competent caring. Patients need to feel safe in order to feel comfortable.
2. Administer medications to ease discomfort.
Pain medications, antiemetics, and antianxiety medications are necessary to increase comfort and improve rest and healing.
3. Consider nonpharmacologic interventions.
Warm blankets can increase comfort. Cool rags can ease nausea or feeling overheated. Pillows and repositioning prevent physical discomfort.
4. Explain procedures and care before implementing.
Patients are often at the mercy of others and can feel vulnerable when sick and hospitalized. The nurse should always explain everything they do before they do it. Explain the steps of starting an IV, obtaining vital signs, or how a medication might make them feel. This drastically decreases fear and discomfort when a patient knows what to expect.
5. Offer relaxation and calming techniques.
A patient feeling overwhelmed or anxious may need a calming voice to remind them they are safe. Teach breathing and meditation exercises.
6. Keep the environment stress-free.
After asking permission, help the patient clear their environment. Scattered papers, old food, and cluttered tables can feel overwhelming. Reduce stimuli by decreasing outside noise, dimming the lights, and ensuring privacy by keeping the door closed.
7. Offer hygiene care or items to clean themselves.
Feeling unclean has a huge impact on comfort. If the patient cannot clean themselves, offer a bed bath with skincare and oral care. If the patient is independent, provide supplies such as a toothbrush, comb, and deodorant.
8. Offer chaplain services for spiritual distress.
The patient may require a visit from the chaplain if their discomfort is related to a spiritual issue.
9. Encourage family visitation.
Encourage the patient to have their family and friends visit to improve their mood (unless this is the cause of their discomfort). If they do not feel well enough for visitors, recommend a phone call.
10. Recommend distractions.
A patient who is worried or anxious may need to be distracted. Drawing or reading a book can be helpful.
11. Respect cultural values.
Being hospitalized can feel lonely, and the patient may feel out of their comfort zone. Respect their privacy, ask before touching them, and do not push topics they are uncomfortable discussing.
12. Acknowledge their thoughts.
The nurse should patiently listen and reassure the patient that their thoughts and feelings are valid. The nurse does not always have to offer a solution as sometimes the patient only needs to voice their concerns.
13. Be proactive with long-term needs.
The patient may be worried about finances or how they will handle their illness once they return home. The nurse can involve a case manager and begin the discussion of support at home before the patient discharges to ease their uncertainty.
References and Sources
- Clark, M. (2020, July 11). 11 Fast and Easy Ways for Hospitals to Boost Patient Comfort. Etactics. https://etactics.com/blog/patient-comfort
- Cynthia Wensley, Mari Botti, Ann McKillop, Alan F. Merry, A framework of comfort for practice: An integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings, International Journal for Quality in Health Care, Volume 29, Issue 2, April 2017, Pages 151–162, https://academic.oup.com/intqhc/article/29/2/151/2910767
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.